In 2000, close to 200 people became organ donors after death, benefiting over 650 organ transplant recipients.

The first transplant operations commonly performed in Australia were corneal transplants, which date from the 1940s. However, the first organ transplants began around 1963 after medical advances had made kidney transplantation an effective treatment. Since then, transplants of other organs, such as the heart, liver, lungs and pancreas have also been developed into effective treatments. To corneal transplants have been added transplants of other tissue, such as bone marrow, heart valves, bone and skin. In all, about 30,000 tissue and organ transplants have been performed in Australia.2

Organ donation in AustraliaThis article focuses on the donation of human organs for transplant. Data on organ donation in Australia are maintained by the Australia and New Zealand Organ Donation (ANZOD) Registry, which is funded by the Australian Health Minister’s Advisory Council, New Zealand Ministry of Health, and The Australian Kidney Foundation.1 The information on donors is derived from a form filled out in respect of each organ donor by donation coordinators, and covers every donor in Australia.

ANZOD requires that any reproduction of its data in another publication be accompanied by the following statement:

The data reported here have been supplied by the Australia and New Zealand Organ Donation Registry. The interpretation and reporting of these data are the responsibility of the Editors and in no way should be seen as an official policy or interpretation of the Australia and New Zealand Organ Donation Registry.

In this article, organsrefers to what are medically termed solid organs such as kidneys, heart, lungs, liver and pancreas. Tissue is used to refer to bone marrow, skin, bone, heart valves and corneas.

Organ transplants and waiting listsWhile tissue can be taken from the body after the heart stops beating, the requirements for organ donation are more restricting, and few people die in circumstances that allow them to become organ donors. Organ donation is usually only possible in cases where a patient in an intensive care unit is determined to have suffered brain death, while their heart/lung function is being maintained artificially. Some health conditions rule out donation, and age can also be a consideration, although in the case of kidneys and livers, there is effectively no age limit on donors. It is estimated that currently up to 1%of people who die in a year might have the potential for organ donation.3 Only a small proportion of these actually become donors; hence there is a shortfall in organs for transplantation.

In 1999-2000, there were 35 organ transplant units in Australian hospitals, comprising 20 renal units, 8 liver units, 5 heart units and 2 pancreas units.4 During 2000, there were about 650 transplants from deceased donors. Nevertheless, close to 1,800 people were on a waiting list in January 2001, similar to the number early in 2000.

The contrast between waiting lists early in 2001 and the number of transplants performed over 2000 gives some indication of the extent of the need for organs for transplant, and whether it is being met. The largest waiting list, by a considerable margin, was for a kidney transplant. There were 1,487 people on this list in January 2001. In contrast, over the whole of 2000 there were 350 kidney transplants from deceased donors. This roughly indicates a waiting period of four years for a kidney transplant from a deceased donor. Likewise, the data suggest average waiting periods of one year for a heart transplant, and six months for a liver transplant.

WAITING LIST FOR KIDNEY DONATION, AND KIDNEY TRANSPLANTS

(a) Number of people on waiting list at one date each year.(b) Number of people who received a kidney transplant over entire year from deceased donors.

However, waiting times can vary greatly for individuals, and some people die before organs become available. Information on the lengths of time people spend waiting for a transplant, and the outcomes for them, including death before an organ becomes available, would be necessary for a more detailed discussion of waiting periods.

LIVE DONORS

In Australia, kidney donation is the only widely practised form of organ transplant from live donors. In some other countries, liver transplants from a live donor have become an established treatment, and transplants of parts of the lung, pancreas, and intestine, are also performed.

In Australia, kidney transplants from live donors date from the 1960s. Transplants from live donors have tended to increase at a faster rate than those from deceased donors and thus have increased as a proportion of all donors. Over the 1970s, they increased from less than 1% to 10% of all kidney transplants. They averaged 10% over the 1980s, and 22% over the 1990s. In 2000 there were 180 kidney transplants from live donors, the highest number to date, making up 34% of all transplants in the year. Most of these 180 live donors were biological relatives of the person receiving the kidney (69%). These included 75 parents, 37 siblings and 8 children of recipients. A further 27% of live donors were other (non-biological) relatives, most commonly wives (30) or husbands (15).5

KIDNEY TRANSPLANTS FROM LIVING DONORS - 1994 TO 2000

As proportion of total kidney transplants

Year

no.

%

1994

103

23.4

1995

93

21.1

1996

115

24.2

1997

144

28.7

1998

161

31.1

1999

167

36.9

2000

180

34.0

Source: ANZDATA Registry Report 2001.

DonorsIn 2000, 196 deceased people became organ donors. They made up 0.15% of all people who had died during the year. Between 1989 and 2000 there have been 2,387 donors (an average of 199 per year).

Slightly more than half of the organ donors in 2000 (52%) had died from a cerebral vascular accident such as a stroke or brain haemorrhage. Road trauma was the next most common cause of death (21%), followed by other trauma (11%). Donors ranged in age from less than 1 year to 77 years, with an average age of 41 years. Males made up over half of all donors (57%).

From close to 200 donors, over 650 people benefited through receiving an organ transplant. The number of donors in each State or Territory ranged from 55 in the most populous State, New South Wales, to five or less in Tasmania and the two Territories, which have smaller populations.

ORGAN DONORS - 2000

Donation rate

State/Territory

no.

per million population

per 1,000 deaths

NSW

55

8.5

1.2

Vic.

44

8.5

1.4

Qld.

37

9.2

1.6

SA

30

20.0

2.5

WA

22

11.7

2.1

Tas.(a)

1

n.p.

n.p.

NT(a)

2

n.p.

n.p.

ACT(a)(b)

5

n.p.

n.p.

Aust.

196

10

1.5

(a) Number of donors too low to reliably calculate separate rates.(b) ACT hospitals tend to be used by people in the southern NSW region.

Donation rates in AustraliaIn 2000, the Australian organ donation rate was 10 per million population. There was considerable variation in the rates for the States and Territories. South Australia had the highest rate, 20 donors per million population. In other States for which reliable rates could be calculated, rates of donation ranged from 9 per million population for New South Wales, to 12 for Western Australia.

While calculating the number of donors per million population is a widely accepted way to compare donation rates over time and between areas, it is also useful to calculate rates per 1,000 deaths. This takes account of those differences in donation rates which are caused by differences in the crude death rate. In 2000, the ranking of the Australian States and Territories by the number of donors per 1,000 deaths was the same as their ranking by donors per million population. This suggests that differences in the crude death rate are not a major reason for differences in organ donation rates between the Australian States and Territories.

INTERNATIONAL COMPARISON

Compared with other countries for which information is available, Australia’s donation rate of 10.2 per million population - the number of people who die and become donors out of the (live) population - is low. When organ donation rates are compared per 1,000 deaths, the difference between the donation rate for Australia and some other countries is reduced. In 2000, Australia's donation rate of 1.5 per 1,000 deaths was comparable with estimated rates for New Zealand and for several European countries, including the United Kingdom and Ireland, the Netherlands and Germany.

In 2000, Spain had the highest donation rate, whether calculated per million population (33.9) or per 1,000 deaths (3.9). Over the 1990s Spain had a high and increasing rate of donors per million population. The rate rose rapidly from 14.3 per million population in 1989 to more than 20 in 1991, and had exceeded 30 by 1998. This has been attributed to procedures introduced by a national transplant organisation set up in 1989, which included having donation coordinators in hospitals, training medical staff in requesting donation, and closely monitoring potential and actual donation.6

ORGAN DONATION RATE FOR SELECTED COUNTRIES

Donors(a)

Donation rate

Country

no.

per million population(a)

per 1,000 deaths(b)

Spain

1,345

33.9

3.9

Belgium

256

25.6

2.5

Austria

194

24.0

2.5

United States of America

5,984

22.3

2.6

Portugal

194

19.5

1.8

France

1,016

17.0

1.9

Italy

880

15.3

1.6

United Kingdom and Ireland(c)

845

13.4

1.3

Netherlands

202

12.6

1.5

Germany

1,026

12.5

1.2

New Zealand

41

11.0

1.4

Sweden

97

10.9

1.0

Australia

196

10.2

1.5

(a) Donors, and donation rates per million population, as published by the Council of Europe. (b) Rates per 1,000 deaths have been calculated using the number of donors in 2000 as the numerator and the number of deaths, latest year available, as the denominator. The deaths data for countries other than Australia are as published by the World Health Organisation, and reference years range from 1995 to 1998. The numerator and denominator for these countries are therefore for different years, and the rates per 1,000 deaths are approximate.(c) Combined data are produced for the United Kingdom and Ireland by a transplant organisation.

Donation proceduresHospital procedures regarding organ donation are one factor which can influence donation rates. In 2000, Spain had the highest donation rate in the world and this has been attributed to a range of hospital procedures in place there. There is some evidence to suggest that donation rates in Australia could also be increased with appropriate procedures. In South Australia, intensive care clinicians play an important role in maintaining intensive care patients and requesting donation, and emergency department procedures are also said to have contributed to the high donation rate.7

Research in other States and Territories to identify obstacles to donation has also pointed to the importance of hospital procedures.7, 8 Studies found that the most common reason why donation of organs from a medically suitable potential donor did not occur was that medical practitioners did not request donation after the patient was determined to be brain dead, instead withdrawing, or not starting heart/lung support. A less common reason was that relatives refused consent.

Willingness to donatePublic attitudes to donation also play a part in donation rates. In 2000, a national register was established of people who are prepared to be organ donors after death. Prior to electronic registers being set up, questions included on State drivers' licenses were the main way a person's intentions could be noted. In 2002, the proportions of current license holders who had answered 'yes' to organ donation was 45% in New South Wales and Tasmania, 47% in South Australia and 52% in Queensland. Information was incomplete for Western Australia and Victoria, and was not collected by the transport authorities in the two Territories.9

Survey data from November 1999, indicate that almost half (48%) of people aged 18 years and over had taken steps to be an organ or tissue donor after death.10 About a third (33%) of people had expressed an intention to donate on a driver’s license, 5% carried a signed donor card and 33% had discussed their willingness to donate with family members.

The proportion of people who had taken at least one of these steps to donate was highest in the 35-44 years age group, with those aged 25-34 years ranking second (54%). The lowest proportion was recorded among those aged 65 years and over (29%). Women were somewhat more likely than men to have taken steps (51% compared with 45%).

Regardless of the intentions a person declares, the consent of next-of-kin must be obtained. Market research on organ donation in the 1980s, found that although two-thirds of people said they were either definitely or probably prepared to be donors after death, fewer (38%) said they would definitely or probably donate the organs of next of kin.11 Organisations such as the Australian Kidney Foundation promote the discussion of organ donation within families, in the hope that if people express their intentions while alive, this will alleviate the stress on their relatives if faced with the decision of whether or not to consent to organ donation.

In 2000, 19% of donor families offered consent before it was requested. However, most commonly consent was requested, either by intensive care clinicians or registrars (57%), donor coordinators (22%), or nursing staff (2%). Regardless of who requested donation, most families had contact with a donor coordinator - either face to face (87% of all donor families) or by telephone (8%). This practice was observed in every State and Territory.1

PEOPLE WHO HAD TAKEN STEPS(a) TO BE AN ORGAN OR TISSUE DONOR - 1999

(a) At least one of the following steps was taken: person was a donor on drivers license, carried a signed donor card, or discussed willingness to donate with family.

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